what is dysphotopsia after cataract surgery

Effect of a 7.0 mm intraocular lens optic on peripheral retinal illumination with implications for negative dysphotopsia. Vitals Similarly, a 5-year follow-up study on 320 patients showed hydration of the temporal corneal wound at the end of surgery to possibly increase the risk for transient ND [33]. 2001;27(7):10614. 2023 - Eye Surgery Guide - All Rights Reserved. Patients notice a curved reflection or shaddow on the edge of the vision. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. By using this website, you agree to our A ray-tracing analysis by Erie et al. PD also needs to be distinguished from entoptic phenomena and photopsias, which are not caused by external light sources such as vitreomacular traction [3,8,9,14]. Based on these findings, the use of oval-shaped IOLs has decreased [2,15,16]. The origin of this phenomena Frequently, its the distance for working or using a computer that patients are not happy about, Dr. Basti said, estimating that half of unhappy patients after successful surgery would fall into this category. Kora Y., Marumori M., Kizaki H., Yaguchi S., Kozawa T. Experimental study of small intraocular lenses using an eye model. The PI hole in the right eye was covered by the optics of the IOL, whereas the edge of the IOL overlapped the center of the PI hole in the left eye. A complex interplay of all the factors mentioned above seems to increase ND incidence. Consequently, an extended and more peripheral dark nasal region was created. Together, we are driving the field of ophthalmology forward. Secondary reverse optic capture is the best option for negative dysphotopsia, Fram said. An IOL exchange for a sulcus-fixated round-edged silicon IOL may also be successful (Figure 5) [32,38,76]. 2023 BioMed Central Ltd unless otherwise stated. All rights reserved. Fortunately, advances in lens edge design have minimized this problem. Video images during surgery. These findings were supported by laboratory scatterometry investigations [12]. Careers, Unable to load your collection due to an error. Two main types of dysphotopsia have been described: positive dysphotopsia (PD) and negative dysphotopsia (ND) [1,5]. But beyond that, I dont try to do too much simulation.. Makes me a little "white-knuckled" when night driving and is maddening overall. Some surgeons recommend replacement of the new lens, however that is not guaranteed to remove the recently occuring reflections. Negative dysphotopsias on the other hand produce dark shadows in the temporal region which resemble blinders or crescent shapes; more likely seen among multifocal IOL patients due to design considerations related to design, anatomy and position within their capsular bag. He will typically wait several months before proceeding with an exchange. Contact Us Effect of active evaluation on the detection of negative dysphotopsia after sequential cataract surgery: Discrepancy between incidences of unsolicited and solicited complaints. After cataract surgery, vision may not fully return for a few days. Researchers and clinicians working on this subject are to be congratulated on their relentless efforts to provide a complete understanding of the root causes of dysphotopsia, especially the negative type. van Vught L., Luyten G.P.M., Beenakker J.W.M. Eccentric capsulorhexis and postoperative dysphotopsia following phacoemulsification. Methods: In this randomized clinical trial, consenting adult patients undergoing phacoemulsification were randomized to receive a hydrophobic (Alcon Acrysof . J Cataract Refract Surg 2019;45:219227, 10. TM performed ophthalmic surgery, conducted the report plan, and drafted the manuscript. 2014;157(5):92935. The second category of unhappy patients Dr. Basti sees are those with quality of vision issues. Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision. Dysphotopsia in phakic and pseudophakic patients: incidence and relation to intraocular lens type. Bellucci R. An Introduction to Intraocular Lenses: Material, Optics, Haptics, Design and Aberration. Such phenomena are common after cataract surgery because the intraocular lens (IOL) takes up only about 6% of the crystalline lens volume, leaving plenty of room for the vitreous to move after surgery. Angle kappa is larger in hyperopic patients as significant correlation exists between angle kappa values and positive refractive errors [42]. There is also a possibility that central nervous system adaptation mechanisms could be involved in the ND development, although they are not yet clearly understood [35,36]. NEW YORK If patients are unhappy after their cataract surgery, surgeons need to know how to respond and how to remedy the common causes of dissatisfaction, according to a presentation at OSN . noted PD symptoms in 80% of patients after MFIOL implantation, although only 5% of the patients found the symptoms as bothersome [57]. De Vries et al. Understanding causes can help avoid or reduce impact. In addition, Jabbour et al. The PI hole in the right eye was covered by the optics of the IOL, whereas the edge of the IOL overlapped the center of the PI hole in the left eye (Fig. Generally, the better the early postoperative visual acuity, the more they complain. Makhotkina N.Y., Nijkamp M.D., Berendschot T.T.J.M., van den Borne B., Nuijts R.M.M.A. J Cataract Refract Surg 2019;45:13351339, 11. A PI hole created during intrascleral IOL fixation may cause postoperative positive dysphotopsia depending on the position of the IOL edge. The https:// ensures that you are connecting to the Dysphotopsias are visual symptoms that some patients may notice in the first few weeks following cataract surgery. For symptoms of negative dysphotopsia, Dr. Chang said he would wait at least 612 months before considering any surgical intervention, which he has never had to do. What Tests Are Done Before Cataract Surgery. Davison J.A. He added that its important not to proceed with the second eye until youre certain the patient is happy with the first. PD disappeared completely after surgical closure of the PI hole, supporting this hypothesis. Like. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The image depicted here is our own property. reported that corneal staining with black ink for dysphotopsia (e.g., glare and light scatter) after LI in phakic eyes weakens its long-term effects [8]. A study of eleven patients with ND showed that symptoms may be objectively evaluated by kinetic perimetry testing as statistically significant constrictions of the peripheral temporal and inferior visual field [26]. Patients usually experience these phenomena near the visual axis, especially in low mesopic or scotopic conditions when the pupils dilate [2,6,9]. However, ND could be more commonly associated with acrylic IOLs with a sharp-edge design and less commonly with silicone IOLs with a rounded-edge design [2,34,43]. MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. A study by Holladay et al. Burke T.R., Benjamin L. Sulcus-fixated intraocular lens implantation for the management of negative dysphotopsia. Conservative or pharmacological management is possible especially for positive dysphotopsias, but it is often ineffective. The more I can preemptively describe the symptoms and resolution to the patient, the more it seems to diffuse their concerns, Dr. Chang said. London SE1 1TY Feeling should start to return to your eye within a few hours of surgery, but it may take a few days . Dysphotopsias are unwanted visual phenomena that occur after cataract surgery. J Cataract Refract Surg 2000;26:810816, 2. Your privacy choices/Manage cookies we use in the preference centre. Masket S., Geraghty E., Crandall A.S., Davison J.A., Johnson S.H., Koch D.D., Lane S.S. Undesired light images associated with ovoid intraocular lenses. INTRODUCTION. In theory, this may be associated with a greater potential to prevent ND, provided the IOL is oriented accordingly. A 52-year-old man underwent IOL extraction and intrascleral IOL fixation in the right eye in 2018 and the left eye in 2020 because of IOL subluxation in both eyes. Hydrophobic, hydrophilic, acrylic, and silicon IOLs can all be associated with ND [28,29,32]. Diagnostic measures should include measuring uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), distance corrected visual acuity (DCVA), distance corrected near visual acuity (DCNVA), subjective and objective spherical equivalent refraction, monocular contrast sensitivity testing, intraocular pressure (IOP) measurement, and slit-lamp examination [10,57]. The effect of the material of IOL and RI on the occurrence of PD symptoms is not unequivocally explained. also found horizontal haptic positioning to reduce ND incidence [7]. J Cataract Refract Surg 2000;26:145147, 3. At Friday's Refractive Surgery Subspecialty Day, Jack T. Holladay, MD, offered an overview of how to categorize and address these visual disturbances. Surgeons who perform intrascleral IOL fixation or transscleral suture fixation of the IOL should be aware that creating an intraoperative PI hole may cause postoperative PD. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. The third category of patients unhappy after cataract surgery are those with physical discomfort, like dry eye or a stinging sensation from eye drops, Dr. Basti said. Clinical performance of Alcon SA30AL and SA60AT single-piece acrylic intraocular lenses. Patients most commonly experience this phenomenon in photopic conditions when the pupil is narrow [27,28]. Poor Long-Term Outcomes of Keratopigmentation With Black Ink for the Treatment of Dysphotopsia Secondary to Laser Peripheral Iridotomies. Holladay JT, Lang A, Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. This approach likely minimizes the risk of falls due to loss of contrast and depth perception, he added. Why Cant You Drink Water Before Cataract Surgery? Our new name is a reflection of our shared mission to provide the highest level of care to our patients across the Twin Cities. found ND incidence 4 weeks after surgery to be decreased from 16% to 8% when optichaptic junctions were horizontally oriented [49]. PubMed The 2023 ESCRS Annual Congress will pack more punch on the opening and closing days. After cataract surgery, some patients experience an irregular crescent-shaped shadow in their visual field known as negative dysphotopsia - this usually resolves within a few months on its own; if this symptom arises it's important to contact an ophthalmologist immediately for assessment and possible treatment options. However, the claim that a larger distance between iris and IOL increases the rate of ND has not been confirmed by later studies [27,32,40]. 4a-f), thereby closing the PI hole (Fig. However, the mechanism of dysphotopsia may not be simple, as there are report of dysphotopsia being induced by the tear meniscus even when the LI hole is hidden by the eyelid [7]. High RI of the optic material, in particular, acrylic IOLs, moves forward the anterior and the posterior border of the shadow reducing its width compared to silicone IOLs. A large angle alpha causes the eye to be turned more temporally and thus increases the exposure of functional nasal retina [7,24]. ; investigation, A.P., X.L., and G.P. A study by Masket et al. Satisfaction and dysphotopsia in the pseudophakic patient. Monovision surgical techniques for correcting presbyopia may induce less PD compared to MFIOL implantation [64]. 1976;7(2):98103. J Cataract Refract Surg 2015;41:22912312, 15. Bonsemeyer M.K., Becker E., Liekfeld A. Dysphotopsia and functional quality of vision after implantation of an intraocular lens with a 7.0 mm optic and plate haptic design. For those with dryness, routine postop drops have usually stopped around this time, he said, and many patients with dysphotopsia will see it resolve after several months as well. Enter your email below to stay updated. Accordingly, even if PD occurs, the symptoms may disappear spontaneously. Cooke, D.L., Davison, J.A., Folden, D.V., Holladay, J.T., Masket, S. (2014) Treating, eliminating negative dysphotopsia. Fram said this includes determining when the patient became unhappy right after surgery or later and why. A 2011 study by Masket and Fram noted an increase in ND symptoms with miotic agents and their improvement after the application of mydriatic agents [27]. A PI hole that forms during intrascleral IOL fixation allows light into the lens surface and bounce off its edge, creating symptoms of dysphotopsia that gradually vanish when surgically closing off this opening providing further support for this theory. However, the intervention can be linked to postoperative complications, such as earlier opacification of the posterior lens capsule, capsular block syndrome, iris chafe, and postoperative myopic refractive error (myopic shift) [27,29]. In this case, PD did not develop in the right eye, even though the PI holes were of the same size and position on the nasal or supranasal sides in both eyes. We look at their personality type, we look at night driving checklists, we show simulations, but sometimes were just wrong. Similar findings were observed by Masket et al. This includes dysphotopsias, or undesirable optical patterns on the retina. What he will do is discuss with the patient the distances at which he or she likes to hold things. Tester R., Pace N.L., Samore M., Olson R.J. Dysphotopsia in phakic and pseudophakic patients: Incidence and relation to intraocular lens type (2). In theory, a larger pupil would expose the IOLs edge to more light rays, which by internal reflection would cause an illuminated arc-like pattern on the peripheral retina [11,15]. Masket et al. One has to be carefull in diagnosing dysphotopsia as it may be confused with a retinal break. PD occurrence may also depend on the IOL diameter. Recent evidence suggests that dysphotopsia (PD) could be caused by square-edged IOLs used during cataract surgery to reduce posterior capsular opacification. Ultrasound biomicroscopy may be useful to determine IOL-to-iris distance [31]. The authors declare no conflict of interest. On the other hand, Davison JA states that the use of miotic therapy does not improve PD symptoms [6]. ; validation, A.P., X.L., and G.P. your express consent. A study on 86 patients comparing two hydrophilic acrylic IOLs with the same RI showed the 7.0 mm optic diameter IOL to have reduced ND incidence compared to the 6.0 mm diameter IOL [10]. Negative dysphotopsia after intraocular lens implantation irrespective of design and material. Incidence of positive dysphotopsia is way higher than 1.5% of patients. I find using a low index of refraction IOL, like LI61AO (Bausch + Lomb), is a dysphotopsia killer, and so this is my go-to, Fram said. Moreover, the use of such IOLs could result in decreased contrast sensitivity [23]. When counseling patients preoperatively, Dr. Chang doesnt mention every possible complication that can occur because he doesnt want to overload the patient. A problem well stated is a problem half solved. 1-3 The symptoms associated with pseudophakic dysphotopsia were further divided into positive and negative types. Leadership and Business Innovation Masterclass aims to expand the skill sets of all ophthalmologists. Meacock et al. The subjective symptoms of PD completely disappeared, the postoperative corrected VA was unchanged from the preoperative corrected VA, higher order aberrations measured with wavefront analyzer KR-1W (Topcon, Tokyo, Japan) showed no abnormalities before and after surgery, and no iris capture of IOL or intraocular pressure elevation has been observed to date. found that translucent or opaque occlusion of the fellow eye resulted in subjective improvement of symptoms [35]. It may be that the patient wanted to be able to read, and the surgeon targeted a refractive error of 2.0 or 2.25, but some people are used to reading at different distances than others. And so, the first step is to establish the history.. Patients with complicated cataract, poor mydriasis, cataract secondary to trauma, history of prior ocular surgery, coexistent ocular pathologies like glaucoma, macular degeneration, retinitis pigmentosa, diabetic retinopathy, uveitis that may compromise surgical safety and visual outcomes, eyes with an IOL power of 17 D or 25 D, and any history of dysphotopsia in the other eye were . Karhanov M., Pluhek F., Mlk P., Vlil O., n M., Mareov K. The importance of angle kappa evaluation for implantation of diffractive multifocal intra-ocular lenses using pseudophakic eye model. A study by Masket et al. Because the cause of the symptoms could not be identified, the patient visited our department. J Cataract Refract Surg 2002;28:11121123, 5. Occasionally, a PI hole is created intraoperatively to avoid these postoperative complications, but there is no clear consensus on the size and position of the PI hole. The scotoma may be evaluated by visual field testing [26]. His preferred approach is the use of EDOF or hybrid IOLs that give a fuller range of vision, so both eyes have distance, compared to monovision where there is a discrepancy, he said. Most people who have this procedure can go for a walk as early as 1 day after the procedure. The operation. A study on 305 patients found a 2.3-fold decrease in ND incidence one day after cataract surgery when one of the two optichaptic junctions of the IOL was positioned inferotemporally compared to the control group with vertical positioning of the junctions [43]. However, the difficulty is that staining the cornea above the edge of the IOL requires staining the area near the center of the cornea. Specifically, 5.5 mm diameter IOLs were linked to an increased risk for dysphotopsia compared to 6 mm diameter IOLs [13]. First described in 1963 as a dilated, fixed pupil after penetrating keratoplasty, it is also a symptom of other surgical procedures. What are symptoms of dysphotopsia? MFIOLs are associated with higher incidence of PD symptoms compared to monofocal IOLs [50,51,52]. to maintaining your privacy and will not share your personal information without Purpose: The purpose of this study is to find incidence of negative dysphotopsia (ND) in eyes undergoing clear corneal phacoemulsification and identify its causes including corneal wound hydration and type of intraocular lens (IOL). These visual symptoms typically resolve soon after surgery and rarely cause persistent problems for patients. ; methodology, A.P., X.L., and G.P. Therefore, surgical closure of the PI hole, as in this case, may be the most effective treatment. Certain types of light exercise may be safe within a few days after cataract surgery. New preventative approach for negative dysphotopsia. Kelava L., Bari H., Bui M., ima I., Trkulja V. Monovision Versus Multifocality for Presbyopia: Systematic Review and Meta-Analysis of Randomized Controlled Trials. However, if the problem continues a few months after surgery, ophthalmologists must step in to provide a treatment. (page 96) to perform optical modeling using ray-tracing software to simulate retinal illumination from an extended light source for pseudophakic eyes with different IOLs to verify their effect on ND. Masket S, Fram NR. Masket S., Rupnik Z., Fram N.R. According to the manufacturer, both IOLs also have a 360-degree lens epithelial cell barrier on the posterior surface, which reduces the effective optic diameter to 6.5 mm for the Aspira-aXA IOL and to 5.5 mm for the Aspira-aA IOL. Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia. Sharma P., Kalia S., Chouhan J.K. National Library of Medicine One study suggests that a nasal anterior capsule overlying the anterior nasal part of the IOL optic could be a factor determining the presence of ND by reducing the intensity of rays transmitted to the retina due to ray reflections [34]. Light entering an eye from the temporal field of vision crosses the pupil and encounters the flat edge of a high-index-of-refraction intraocular lens. Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging. 5). One of the most common causes of patient complaints is pseudophakic dysphotopsia, comprising diffractive, negative and positive dysphotopsias. Recovery Cataract surgery. You want to lift up before you start rotating so you dont cause a zonulopathy, and by lifting up you can just go ahead and release that.. When noninvasive measures fail to improve symptoms, a surgical approach may be considered. (2013) Neodymium:YAG laser anterior capsulectomy: Surgical option in the management of negative dysphotopsia. In this study, 13% of the patients who received wound hydration experienced ND compared to 5% who did not receive wound hydration [33]. Its incidence in the immediate postoperative period was described to be as high as 49%, decreasing to 0.2% to 2.2% over the following 12 months.14 Factors that have been described as contributors to PD include the presence of a square, truncated IOL optic edge, IOL materials with high refractive index, and IOLs with peripheral nonimaging features that reduce the functional optic diameter.14,15 Typical negative dysphotopsia (ND), however, is usually reported by patients as a dark, temporal peripheral arc-shaped shadow or line. Osher R.H. ND is a diagnosis of exclusion where other possible ocular and neuro-ophthalmological pathologies should be excluded [29]. Furthermore the postion of the new lens is slightly different than the old lens now removed. Ophthalmology 2021;128:e195e205. Positive dysphotopsia, on the other hand, is more prevalent and usually manifests itself in the temporal field of vision. HHS Vulnerability Disclosure, Help Positive and negative dysphotopsia in patients with acrylic intraocular lenses. PD after cataract surgery is described by patients as glare (due to high refractive index (RI) and reflectance of the IOL), light streaks and starbursts (due to backscatter from the IOL and microsaccades, exacerbated by higher RI of the lens), light arcs (seeing the edge of the IOL, usually at night), rings and haloes (more commonly seen with multifocal IOLs (MFIOL . The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Although only occurring in a minority of cases, photic phenomena is one of the primary sources of patient dissatisfaction following uncomplicated phacoemulsification and in-the-bag intraocular lens (IOL) implantation procedures. The modeling shows that a space is created between the posterior surface of the iris and the anterior surface of the IOL when the IOL is fixated within the capsular bag, a space that is not present in the phakic eye. Influence of the intraocular lens optic-haptic junction on illumination of the peripheral retina and negative dysphotopsia. MFIOLs can partially satisfy patients expectations, but they also produce gaps in the range of vision and are associated with halos, glare, and reduced contrast sensitivity [54]. Dysphotopsia visual symptoms are divided into two broad categories: Positive Dysphotopsia: symptoms may include glare, light streaking, halo effect, general sensitivity to light, and peripheral flashing arcs of light. No ethical approval was obtained for this study. Modern epikeratophakia offers new option in presbyopia. It requires an anterior capsule opening of 5 mm to 4.8 mm, haptics at 6 oclock and 12 oclock, and the optic overlapping the nasal and temporal capsule, she said. Folden, D.V. Fixation holes facilitate capture of the IOL within the anterior capsulotomy. YouTube J Cataract Refract Surg 1999;25:748752, 6. Although the incidence rate of PD at 1year after cataract surgery is 0.22.2% [1, 3], there might be some cases in which a patient with abnormal photopic phenomena is under observation without identifying the cause. showed that diffractive MFIOLs are more commonly associated with glare phenomena compared to refractive MFIOLs, although the difference might not be clinically relevant [53]. Erie J.C., Simpson M.J., Bandhauer M.H. The same research mentioned a number of IOL properties that could affect ND incidence, including high RI, higher dioptric power, equi-biconvex or plano-convex shape, negative aspheric surface, and IOL diameter [34]. We try in the beginning to manage expectations, Nicole R. Fram, MD, said. Figure 2. Negative dysphotopsia: causes and rationale for prevention and treatment. Schwiegerling J. Patient outcomes following implantation with a trifocal toric IOL: Twelve-month prospective multicentre study. Distal to the edge, a shadow is cast onto the nasal retina, creating a negative dysphotopsia. The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification. By implanting a secondary IOL in the ciliary sulcus, a piggy-back IOL, a larger area of the peripheral retina gets illuminated [73], which improves ND in approximately 73% of the cases [73]. When specifically questioned about it, patients report an incidence of ND of 15% to 20% early postoperatively, which is reduced to approximately 3% at 1 year, seemingly due to neuroadaptation.15 Its origin is less understood and frequently described as multifactorial. 2021;128(11):e195205. The disappearance of ND symptoms weeks after surgery could be associated with resolution of corneal edema [31]. This theoretical explanation is supported by patients complaining of glare symptoms occurring in low mesopic or scotopic light conditions such as reading at night with a light source on the side or driving at night (Figure 2A) [2]. IOLs with anterior radius curvature of 17 mm would minimize surface reflections [18]. showed this technique to be highly successful in eliminating or preventing ND [29]. A limited number of case reports showed that a Nd:YAG laser capsulotomy of the anterior nasal capsule may be effective in some patients with ND [47,48]. showed that a sharp-edge IOL design increases the probability of a thin, ring-like image projecting onto the midperipheral retina [15]. Cataract surgery is a straightforward procedure that usually takes 30 to 45 minutes. Google Scholar. Holladay J.T., Lang A., Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. Examination of symptomatic patients should include UDVA, DCVA, subjective refraction, IOP measurement, photopic and scotopic pupil size measurement, exophthalmometry, slit-lamp examination, and anterior segment OCT [31]. Entoptic phenomena. Mendicute J., Kapp A., Lvy P., Krommes G., Arias-Puente A., Tomalla M., Barraquer E., Rozot P., Bouchut P. Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens. The second eye rarely needs to be postponed. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. Another study on 95 patients showed that hyperopic subjects might be more susceptible for ND development [30]. The retinal shadow occurred in pseudophakic conditions with a small 2.5 mm pupil diameter, while the shadow disappeared when the pupil was 5 mm wide [34]. I almost never intervene in the first month, he said, adding that 3 months is about the time he thinks the patient needs in order to adapt or at least give it a true attempt. You may have a pad and plastic shield over your treated eye when you leave hospital, which can usually be removed the day after surgery. did not show any significant decrease in PD incidence by using square-edge IOLs with frosted edge [23].

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